Provider Demographics
NPI:1891737011
Name:TARANTINO, JOSEPH A (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:TARANTINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 07 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-0000
Mailing Address - Country:US
Mailing Address - Phone:718-641-7180
Mailing Address - Fax:718-641-7326
Practice Address - Street 1:94 07 156TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2826
Practice Address - Country:US
Practice Address - Phone:718-641-7180
Practice Address - Fax:718-641-7326
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0050941213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01525837Medicaid
NYU50603Medicare UPIN
NY01782Medicare PIN